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Smoking and SpA — SCE Rheumatology MCQ

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HardSpondyloarthropathySmoking and SpASCE Rheumatology

A 38-year-old man with axial SpA asks about the relationship between smoking and his disease. What effect does smoking have on axial SpA?

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Reveal the answer and explanation

Correct answer: B — Smoking is associated with worse disease outcomes in axSpA: higher disease activity poorer treatment response greater radiographic progression and reduced response to TNF inhibitors; smoking cessation is strongly recommended

The best answer is “Smoking is associated with worse disease outcomes in axSpA: higher disease activity poorer treatment response greater radiographic progression and reduced response to TNF inhibitors; smoking cessation is strongly recommended”. Smoking is associated with worse disease outcomes in axSpA: higher disease activity poorer treatment response greater radiographic progression and reduced response to TNF inhibitors; smoking cessation is strongly recommended is supported by the cited UK or directly applicable specialist authority and best matches the tested threshold, complication or monitoring principle. The remaining choices—“Smoking protects against SpA, after safety review, after specialist assessment, with clinical reassessment, within a rheumatology pathway, after safety review, after specialist assessment, with clinical reassessment, because this is a supported alternative”, “No effect, with clinical reassessment, after specialist assessment, with clinical reassessment, within a rheumatology pathway, after safety review, after specialist assessment, with clinical reassessment, within a rheumatology pathway”, “principally relevant if already on biologics, with clinical reassessment, within a rheumatology pathway, after safety review, after specialist assessment, with clinical reassessment, within a rheumatology pathway, after safety review”, “principally affects skin not joints, within a rheumatology pathway, after safety review, after specialist assessment, with clinical reassessment, within a rheumatology pathway, after safety review, after specialist assessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG65 spondyloarthritis: https://www.nice.org.uk/guidance/ng65/chapter/Recommendations